| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BENEFIT CONCEPTS AND SERVICES INC3 | 8 OLD GROVE LN ALTAMONTE SPRINGS, FL 32701 | SUN LIFE ASSURANCE COMPANY OF CANADA | $607 | — | $607 | 12.98% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| OPTUM RX INC. EIN 33-0441200 PHARMACY BENEFIT MANAGEM | Other fees; Float revenue; Claims processing; Direct payment from the plan Service code 12 | — | $116K |
| NORTHWESTERN MEM HOSP EIN 37-0960170 NONE | Direct payment from the plan Service code 50 | — | $67K |
| UMR, INC. EIN 39-1995276 NONE | Claims processing Service code 12 | — | $37K |
| NORTHWESTERN MEDICAL FACULTY F EIN 36-3097297 NONE | Direct payment from the plan Service code 50 | — | $28K |
| FRANCISCAN HEALTH OLYMPIA FIELDS EIN 36-2167869 NONE | Direct payment from the plan Service code 50 | — | $19K |
| THE COMMUNITY HOSPITAL EIN 35-1107009 NONE | Direct payment from the plan Service code 50 | — | $19K |
| ADVOCATE ILLINOIS MASONIC EIN 36-3196629 NONE | Direct payment from the plan Service code 50 | — | $16K |
| LABORATORY CORPORATION OF AMER EIN 13-3757370 NONE | Direct payment from the plan Service code 50 | — | $12K |
| UNIVERSITY OF CHICAGO MEDICAL EIN 36-3488183 NONE | Direct payment from the plan Service code 50 | — | $11K |
| QUEST DIAGNOSTICS WOOD DALE EIN 36-4257926 NONE | Direct payment from the plan Service code 50 | — | $10K |
| PHYSICAL MEDICINE GROUP OF ILL EIN 81-1728830 NONE | Direct payment from the plan Service code 50 | — | $10K |
| INGALLS MEMORIAL HOSPITAL EIN 36-2170866 NONE | Direct payment from the plan Service code 50 | — | $10K |
| HOLY CROSS HOSPITAL EIN 36-2177139 NONE | Direct payment from the plan Service code 50 | — | $9K |
| MACNEAL HOSPITAL EIN 36-3332852 NONE | Direct payment from the plan Service code 50 | — | $9K |
| DUPAGE MEDICAL GROUP LTD EIN 36-2657618 NONE | Direct payment from the plan Service code 50 | — | $7K |
| CAM MEDICAL GROUP SC EIN 42-1717100 NONE | Direct payment from the plan Service code 50 | — | $6K |
| SPECIALISTS IN MEDICAL IMAGING EIN 47-3109067 NONE | Direct payment from the plan Service code 50 | — | $5K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 72 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 72 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 82 | $5K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 82 | $385K |
| Other | SUN LIFE ASSURANCE COMPANY OF CANADA | 82 | $5K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 82 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.